Mastitis

What is Mastitis?

Article by Nadine Stewart

What is Mastitis?

Mastitis is an inflammatory breast condition that is often characterised by a blocked milk duct/s that may or may not be associated with bacterial or fungal infection. A blockage generally occurs when the breast milk being produced cannot drain from the breast, resulting in the thickening of stationary milk, which leads to a blockage of the associated milk duct/s. Mastitis usually occurs in breastfeeding mothers, many within the first three to six months postpartum or during weaning. However, mastitis can occasionally arise during pregnancy and in women who are not breastfeeding.

The symptoms of mastitis can include:

  • Hard, palpable, thickening of the breast tissue
  • Reddening of the breast tissue
  • Flu-like symptoms including fever, achiness and fatigue
  • Symptoms generally occur and progress quickly, often within 24 to 48 hours

There are several factors that can lead to mastitis, including:

  • Infrequent feeding, missed feeds or rushed feeds
  • Sore or injured nipples
  • Infant latching difficulties
  • Fatigue, stress and lack of sleep
  • Breast compression, e.g. tight clothing, handbags or poorly fitting bras
  • Engorgement or blocked ducts (see below)

Mastitis needs to be differentiated from a plugged or blocked duct because the latter does not need to be treated with antibiotics, whereas mastitis often requires treatment with antibiotics. 

Are there other Breast Conditions that are similar to Mastitis?

There are other conditions that are similar to mastitis, and these include:

  • Blocked or plugged ducts
  • Engorgement

What is a Blocked or Plugged Ducts?

A plugged duct presents as a painful, swollen, firm mass in the breast, often with overlying skin reddening, similar to mastitis, though not usually as intense. Like mastitis, a blockage generally occurs when the breast milk being produced cannot drain from the breast, resulting in a blockage of the associated milk duct/s.

The symptoms of a blocked or plugged duct/s can include:

  • Hard, palpable, thickening of the breast tissue
  • Reddening of the breast tissue
  • Symptoms generally occur and progress quickly, often within 24 to 48 hours

Blocked ducts will almost always resolve spontaneously within 24 to 48 hours after onset. When the block is present, the baby may be fussy when nursing on that side, as milk flow may be slower than usual and may contain a higher salt concentration.

What is Engorgement?

Engorgement is when the breasts overfill with fluid due to a rapid production or overproduction of milk. Engorgement usually occurs in breastfeeding women in the first week postpartum or with changes in breastfeeding, e.g. transition to weaning.

The symptoms of engorgement can include:

  •  Swelling of the breasts
  • Tight, hard and shiny skin
  •  Achy and tender breast tissue
  • Flattening of the nipples
  • Symptoms generally occur and progress quickly, often within 24 to 48 hours

Diagnosis of Mastitis and Blocked Ducts

There are many similarities between mastitis and a blocked or plugged duct. However, mastitis is usually associated with fever, more intense pain and reddening of the breast tissue. As you can imagine, it is not always easy to differentiate mild mastitis from a severely blocked duct. In addition, a blocked duct can lead to mastitis if it does not resolve.

To make a diagnosis of mastitis, there must be an area of tissue thickening and pain and reddening of the breast. The absence of such an area in the breast means that the mother does not have mastitis. Flu-like symptoms or fever alone are not enough to make the diagnosis of mastitis.

Physiotherapy Treatment Options for Mastitis and Blocked Ducts

There are many treatment options for mastitis and blocked ducts, including:

  • Education
  • Continue regular breastfeeding on the affected side (if able). If you cannot continue breastfeeding, express your milk with a breast pump or self-expression. Continuing to breastfeed helps mastitis and blocked ducts to resolve more rapidly. There is no danger to the baby.
  • Positional feeding to assist with drainage of the affected area. One way of doing this is to position the baby so that their chin “points” to the area of tissue thickening. Thus, if the blocked duct is in the outer lower area of your breast (about 4 o’clock), the football position would be best.
  • Heat on the affected area before and occasionally after feeding (hot water bottle) also helps.
  • Ice packs to assist with settling inflammation after feeding if required
  • Gentle self-massage
  • Regular rest (Not always easy, but take the baby into bed with you)
  • Stay hydrated
  • Therapeutic ultrasound
  • K taping
  • Gentle stretches and breathing exercises

If a blocked duct has not settled within 48 hours, therapeutic ultrasound often assists with the clearance of the blockage. 

If ultrasound works, one treatment will improve your symptoms, and a second one will finish the job in most cases.  

Additional Treatment Options for Mastitis and Blocked Ducts

  • Always consult your doctor for assessment. If you have mastitis, you may need to be treated using medications, including antibiotics.
  • Your doctor may also recommend additional imaging to rule out the possibility of an abscess.
  • Some probiotics have also been used in the prevention and treatment of mastitis and blocked ducts. However, discuss these options with your doctor to ensure that these options are safe and suitable for you to take based on your situation.
  • A consultation with a lactation consultant for additional information and treatment is also recommended, especially if your baby is experiencing latching difficulties.

PhysioWorks provides therapeutic ultrasound for mastitis. For more information, please ask your physiotherapist.

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Women's Health Physiotherapy Appointment FAQs

Q: What Do You Need To Bring To Your Women's Health Appointment?

A: Please bring any information regarding your condition from your GP, medical specialists or other health care providers with you to your appointment. You will also need to arrive 10 minutes before your appointment to fill out some paperwork. Alternatively, we can email information to you before your appointment.

Q: What Do You Wear To Your Appointment?

A: Please wear clothing that you can move around freely in.

Q: Will the Information That You Provide During Your Appointment Remain Confidential?

A: Yes. All the information you provide in your appointment will remain confidential, and your physiotherapist will only communicate with other healthcare providers involved in your care with your consent. We also conduct your appointment in individual rooms to ensure that what you say remains confidential. The one exception to this is cases of rectus diastasis, which we may treat in the general physiotherapy curtained consulting area unless otherwise requested.

Q: How Long Will Your Appointment Be?

A: The length of the appointment can vary depending on the condition that we treat.  Your initial women's health appointment will normally take 1-hour. Mastitis and rectus diastasis appointments will normally take 30 to 40-minutes. For information specific to your needs, please call our receptionist.

Q: What Will Your Women's Health Physiotherapy Appointment Cost?

A: The cost of the session can vary depending on the condition that will be treating. Please call our reception staff at Ashgrove (Ph: 3366 4221) for further information.

Q: Is Your Women's Health Physiotherapy Appointment Claimable Under Private Health Insurance?

A: Yes. Please bring the private health insurance card with you to your appointment to process your claim on the spot.

Q: Is Your Appointment Covered Under An EPC/Medicare Referral?

A: Yes, we do accept GP referrals under EPC guidelines. However, but due to the extended time allocated by your women's health physiotherapist, there will be a gap payment to cover the total cost of your consultation after the Medicare rebate is applied. Please call our reception staff for specific information.

Women's Health Conditions

Women’s Health Physiotherapy incorporates the assessment and treatment of a large number of women-specific conditions including:

Electric Muscle Stimulation (EMS)

EMS Machines

Electronic muscle stimulation (EMS) may help you to strengthen weak muscles.

ems-electronic-muscle-stimulation

How Does Electric Muscle Stimulation Assist Strengthening?

There are several theories on how an EMS Machine may assist in muscle strengthening. One potential reason is that when you maximally contract a muscle, at best, only 30% of all your muscle fibres are in a state of contraction. The remaining 70% are dormant and awaiting recruitment when the contracting fibres fatigue. With EMS, you can potentially electrically stimulate these resting muscle fibres to improve their strength. Clinically, EMS appears to be more effective when the muscles are frail and you have difficulty performing regular anti-gravity exercises.

Another reason that EMS potentially works is via an improvement in the recruitment of nerve conduction rates. Explained, it takes approximately 10000 repetitions for your brain to learn how to quickly send a message to your muscles via the quickest nerve pathways. This contraction pattern becomes your "memory engram". The more frequent your muscle recruits, the better your body becomes at finding the fastest way to recruit that muscle. EMS can potentially provide you with repeated contractions to accelerate this learning process.

To achieve your best outcome, we recommend that you seek professional advice on best utilising your EMS machine from your local physiotherapist who has a particular interest in EMS muscle retraining.

Important EMS Machine Information

Use your machine only as directed. A TENS machine and an EMS machine are electronic medical devices. Always read the label and instruction manual. A TENS machine may assist you in modest short-term pain relief. Consult your doctor/healthcare professional before use and if symptoms persist.

EMS Machines

Physiotherapist Prescribed Exercises

Why Do Physiotherapists Prescribe You Exercises?

The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning, or recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose.

Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.

What Exercises Should You Do?

Your exercises shouldn't be painful. Would you please be cautious with some overzealous exercise prescribers who believe that the more painful the activity, the better? This isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person.

You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.

What Happens When You Stop Exercises?

Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures inadequately support and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage.

It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific to your needs.

The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.

Would You Stop Your Daily Prescription Drugs?

Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you stop taking your regular blood pressure medication because you were too busy or didn't think it worked? We would hope not!

Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work if you don't take them as prescribed by your health professional.

So, next time you skip your "exercise dose", remember that you are not putting your health first. If you have any questions, please get in touch with your Physio Works physiotherapist for your best care.

Physiotherapy Private Health Insurance Rebates

PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for most of your treatment fees, leaving you with only a small gap payment.

However, Private Health Funds vary their rebates payable depending upon the level of cover you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly, others haven't, with rebates similar to what they were a decade ago.

HICAPS - Instant Health Fund Claims

Most health funds are members of the HICAPS instant claims system.  Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. Please visit Hicaps for the latest funds for more information, which can use their instant claiming system.

Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.

Third-Party Insurers

PhysioWorks practitioners are registered providers for government, Workcover and insurance companies, including:

  • Workcover
  • InjuryNet
  • Australia Post; Coles Myer; Woolworths
  • Medicare
  • Department of Veterans' Affairs
  • CTP & Sports Insurers

The internet is full of potentially unreliable information. Please source trusted healthcare information from reputable websites such as the following.

https://www.health.gov.au/

https://australian.physio/

https://www.ama.com.au/

British Medical Journal

https://www.mayoclinic.org/

https://www.hopkinsmedicine.org/